H.R. 6494

Territories Health Equity Act of 2025

Sponsor: Stacey E. Plaskett

4 cosponsors
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Official summary

Written by the Congressional Research Service.

Territories Health Equity Act of 2025

This bill alters provisions relating to the treatment of U.S. territories under Medicaid, Medicare, and Medicare Advantage.

For example, the bill

  • eliminates Medicaid funding limitations for U.S. territories beginning in FY2026,
  • exempts an individual from late-enrollment penalties for Medicare medical services if the individual resided in Puerto Rico as of the date of eligibility and the individual enrolls within five years of such date, and
  • establishes minimum criteria for certain elements used in Medicare Advantage payment calculations for areas within U.S. territories.

The bill also allows residents of U.S. territories who are unable to obtain health insurance through their employer or a health insurance exchange to instead obtain coverage that is at least as broad as the coverage available to Members of Congress and their staff through the District of Columbia exchange.

Text of the bill

Expand all

I MEDICAID

II MEDICARE

A Part A

B Part B

C Medicare Advantage (Part C)

Sec. 221. Adjustment in benchmark for low-base payment counties in Puerto Rico

Section 1853(n) of the Social Security Act (42 U.S.C. 1395w–23(n)) is amended—

(1) in paragraph (1), by striking and (5) and inserting (5), and (6);

(2) in paragraph (4), by striking In no case and inserting Subject to paragraph (6), in no case; and

(3) by adding at the end the following new paragraph:

Text this section adds to the law

(6) Special rules for blended benchmark amount for territories

(A) In general. Subject to paragraph (2), the blended benchmark amount for an area in a territory for a year (beginning with 2026) shall not be less than 80 percent of the national average of the base payment amounts specified in subparagraph (2)(E) for such year for areas within the 50 States and the District of Columbia.

(B) Limitation. In no case shall the blended benchmark amount for an area in a territory for a year under subparagraph (A) exceed the lowest blended benchmark amount for any area within the 50 States and the District of Columbia for such year.

D Part D

III MISCELLANEOUS